Application for Residential Accommodations
NOTE: In order to best track accommodations request, we ask that all applications be submitted electronically to the following email address:
Academic Year Requesting Accommodations (e.g., 2015-2016, 2016-2017, etc.):Name: / Date:
Banner #: 000 / DOB:
Home City, State: / Phone #:
SLU E-mail Address: / Major:
Check Year: / Fr / Soph / Jr / Sr / 5th/6thYr / Grad
When do you expect to graduate?
Requesting academic accommodations for the following diagnosed disabilities
(check all that apply):
ADD/ADHD / Blindness / Deaf/Hard of HearingLearning Disability / Orthopedic Impairment / Physical Impairment
Traumatic Brain Injury / Use of a Wheelchair / Visual impairment
Psychological Disability; please specify:
Other; please specify:
Do you require a personal care attendant (PCA)*?:
Yes
No
*Please note that if a 24-hour PCA is required to meet your needs, the PCA may be required to pay additional housing costs. The PCA must sign a housing contract, abide by all housing and University policies, and provide Housing and Residence Life with information regarding the qualifications necessary for your care.)
What type(s) of housing accommodation(s) are you requesting?
please provide list of accommodations requested below:
Please indicate why you feel this accommodation(s) is necessary? Please attach an additional page if you want to add more information.
Documentation and Accommodations
I understand that requests for residential accommodations must be accompanied by current documentation of my diagnosed disability. The documentation that I present to Disability Services must meet documentation guidelines relevant to my academic coursework. While I am able to request accommodations, Disability Services has the right to determine appropriate and reasonable accommodations for my situation based on all information provided. Disability Services final accommodation decision(s) may or may not coincide with information presented in the documentation and/or my personal preference. If I am informed that I need additional, up-to-date documentation for a specific accommodation request, I understand I am personally responsible for obtaining this information per general higher education procedures.
All documentation will be solely used for the purpose of determining both service eligibility and reasonable accommodations to be provided. Information from my documentation and specific reference of my diagnosed disability will not be placed on any official academic records or transcripts.
At this time, I have / have not submitted acceptable documentation for accommodation services.
· Failure to submit documentation may result in accommodation services being stopped until appropriate paperwork is submitted. In addition, the Disability Services staff may advise changes to the initially agreed upon accommodations once documentation has been received and reviewed.
I have read the above information and understand the process and my responsibilities.
Student Signature: Date:
Release of Information
I, , acknowledge that the information shared will be used for the sole purpose of applying for housing accommodations at Saint Louis University. I understand that in order to process my housing accommodations request, it may be necessary to share information regarding my disability with university personnel.
I realize that this information is for the housing accommodations process only. Should I need academic accommodations for my classes, I will need further the conversation of access needs with the Disability Services office within the Student Success Center. Although the housing and academic accommodations process are both facilitated through Disability Services, additional forms are required when requesting academic accommodations.
Student’s Signature: Date:
Please submit this form to Disability services, Student Success Center, Busch Student Center 331 or as an email attachment to . Please note that some accommodations, including but not limited to, accessible room locations, emotional support animals, and additional room appliances can take 7-10 days to arrange once approved. Therefore, timely submission of your requests and appropriate documentation are essential.
Your application for accommodations will expire at the conclusion of each academic year.You are required to submit a renewal application each academic year living within the campus residential facilities.